As I wrote, it can be complicated. I was on T3(Cytomel) from 1994 until 2005, when it appeared to stop working. Before that, I felt great, including restoration of erections. I was under the care of an endocrinologist who really didn't make any effort to figure what might be going on. Suddenly becoming refractory to thyroid medication coincided with my relapse into bipolar illness, which was/is treatment resistant. 17 years on a long, frustrating journey to restore my health and function. That's why I say, keep at it and read all the research. It might give you a clue as to what's going on.
DESSICATED THYROID CONTINUES HAVING ZERO EFFECT ON TSH; ELEVATED FT3, NORMAL FT4
- Thread starter mcs
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Updated thoughts - WHY DO I HAVE A PATTERN OF HIGH NORMAL TSH (3.5-4) despite taking NDT?
1) urinary iodine excretion still elevated - dropped all supplemental iodine and continue to see elevated urinary iodine from unknown source. I've checked my meds and diet and cannot find but trace amounts. I know too much iodine suppresses TSH.
2) absorption - I always take my NDT dose first thing in the morning on an empty stomach several hours away from food. If it were an absorption problem then why would T3 be high normal or even over?
3) dose - at 2 grains (130mg) now. If TSH is still not suppressed (0.5-2.0), then the question is should I continue to slowly increase NDT even though T3 is high (as DR. Weston Child's recommends)? I am concerneed that T3 and possibly rT3 will go too high.
4) telltale hypo - trouble losing bodyfat despite training and calorie deficit (yes, I count my kcals).
1) urinary iodine excretion still elevated - dropped all supplemental iodine and continue to see elevated urinary iodine from unknown source. I've checked my meds and diet and cannot find but trace amounts. I know too much iodine suppresses TSH.
2) absorption - I always take my NDT dose first thing in the morning on an empty stomach several hours away from food. If it were an absorption problem then why would T3 be high normal or even over?
3) dose - at 2 grains (130mg) now. If TSH is still not suppressed (0.5-2.0), then the question is should I continue to slowly increase NDT even though T3 is high (as DR. Weston Child's recommends)? I am concerneed that T3 and possibly rT3 will go too high.
4) telltale hypo - trouble losing bodyfat despite training and calorie deficit (yes, I count my kcals).
Nelson Vergel
Founder, ExcelMale.com
How many days did you wait to get TSH tested after you stopped iodine ? Are you 100 percent sure of the quality of your dedicated thyroid ?
I'll be retesting tomorrow. Been off iodine for several weeks now. I've been taking compounded NDT now, no filler except ascorbic acid, much purer than Armour.
Nelson Vergel
Founder, ExcelMale.com
Let us know what your next TSH is like when you get it.
Iodine is part of the structure of thyroid meds. T4/4 molecules of iodine. T3/3 molecules of iodine.
My quick take is that you're still hypothyroid and perhaps, secondary hypothyroid(hypothalamus/pituitary) and if you are dealing with thyroid hormone resistance or HPT malfunction, two grains isn't a high dose. From all my reading, one needs to keep titrating until symptom resolution. What is your doctor saying? At some point in dosing, your TSH should be 0.01 or 0.00. As long as you go slow, there's low risk of becoming hyperthyroid, IMO. If your doctor goes only by labs, you might not resolve symptoms and symptom resolution is the goal.
I'm self treating with t3/t4 research grade drops. Currently, 72 mcg/T3 , 144 mcg/T4. Finally seeing a decrease in depression and increase in energy. Aiming for restoration of erections. I'm not hyperthyroid. BP is 114/120 over 70. Temperature is 98. Mood is balanced. I've been hyperthyroid in previous experiments and it's most uncomfortable, physically and psychiatrically.
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According to all the studies I have read, I seem to check the box for subclinical hypothyroidism or perhaps a mix of it and secondary or tertiary hypothyroidism. I do not have Hashi's thyroiditis, although. Whatever the cause, I hear what you say, upping the dose would be the treatment for all those causes. Doc is pretty much in line with my thinking as we have been titrating based on TSH levels. Been down this road before and have increased my dose as high as three grains but that was years ago. My only concern in raising the dose is getting too much T3 in the process. I have only been at under 1.0 only once about 10 years ago when I was experimenting with T4 only. Go figure. Since then, I could never duplicate that low of a TSH level. Hard to tell what symptoms are related to this.
Never tried intentionally getting hyper for a few days by blasting thyroid meds and then doing a test? This must happen:
On stopthethyroidmadness.com some people are using hydrocortisone to improve adrenal function and uptake of T3 & T4. Not recommending that, just relating what I've read.
It's good you're seeing a knowledgeable or open minded doctor. Some people do well on a larger amount of T4 with a small dose of T3, i.e. 10 mcg liothyronine to 100 mcg levothyroxine. You already know that it's trial and error. In the realm of psychiatry, there are two doctors, Peter Whybrow at UCLA and Michael Bauer in Germany, who use levothyroxine exclusively in treating bipolar. Patients have been titrated up to 500 mcg, daily. Also, a clinic in London uses only levothyroxine. On the other side is psychiatrist Dr. Tammas Kelly, now at the University of Buffalo, formerly in private practice, who uses only T3 in treating mood disorders.
But if you've experienced a good response to T4, only, go back to that or add only a small amount of liothyronine. Another way is to add more T4 to along with desiccated. Several options. Somewhere in all that, IMO, is the elusive sweet spot. You'll get there.
I always had low normal serum ferritin levels. Could low serum ferritin be a culprit in my elevated TSH as indicated in this blog? My recent iron/ferritin labs.
But since T3 increases serum ferritin as is indicated in this study, why wouldn't it be sufficient from taking NDT?
I cannot tolerate any oral iron supplements whatsoever. They bind me up badly and I've tried all commercially-available forms - even formulas from overseas. Taking with ascorbic acid for better absorption doesn't help with the constipation. Oral iron administration is simply toxic to my gut. I have considered IV iron (i.e. Dextran) but it's a hassle and has to be administered in a clinic setting. I also tried transdermal iron patches but observed no improvement in serum ferritin as is supported by this study. Another conundrum.
But since T3 increases serum ferritin as is indicated in this study, why wouldn't it be sufficient from taking NDT?
I cannot tolerate any oral iron supplements whatsoever. They bind me up badly and I've tried all commercially-available forms - even formulas from overseas. Taking with ascorbic acid for better absorption doesn't help with the constipation. Oral iron administration is simply toxic to my gut. I have considered IV iron (i.e. Dextran) but it's a hassle and has to be administered in a clinic setting. I also tried transdermal iron patches but observed no improvement in serum ferritin as is supported by this study. Another conundrum.
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Updated thyroid function tests here.
With the .25 grain increase in NDT from the last labs, we can see noticeable improvement in TSH. I kept it consistent and tested it the same way I did the last time: 3 hours after my dose to see how the medication is working. I know that's not the way to test, but I wanted to see the immediate effect from thyroid replacement.
Question now is do I increase the dose again to keep suppressing TSH until I get to somewhere between 0.5 and 1.0? Also, should I be concerned about elevated free T3?
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T
tareload
Guest
With respect to RT3 as a diagnostic marker of anything outside of inpatient care...
forums.t-nation.com
forums.t-nation.com
Some related information:
forums.t-nation.com
www.ccjm.org
Reverse T3 Does Not Reliably Differentiate Hypothyroid Sick Syndrome from Euthyroid Sick Syndrome
What is TRT and What is NOT TRT
There is some more good study material i will find for you. Edit: Good review in this thread:
forums.t-nation.com
What is TRT and What is NOT TRT
Looks like one of the links in the threads broke. Here is a revised link.
forums.t-nation.com
Some related information:
What is TRT and What is NOT TRT
German engineering on your thyroid: Of course reading stopthethyroidmadness so much more fun! Check out the other articles by Hoerrmann.
forums.t-nation.com
Reverse T3 or perverse T3? Still puzzling after 40 years
Few situations require measuring reverse T3; diagnosis of euthyroid sick syndrome may be one of them.
www.ccjm.org
Reverse T3 Does Not Reliably Differentiate Hypothyroid Sick Syndrome from Euthyroid Sick Syndrome
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But if T4 is metabolizing to RT3, T3 uptake is being blunted. I was doing NDT, then switched to T3/T4 drops. I seemed to be doing fine(no labs yet), but a day and a half ago, I had constipation, a painful hip, dry skin and itchiness all over. I've stopped those drops and now started on T3. Already feeling a bit better. Better mood, more energy. Some poorly metabolize T4 or something physical or emotional is negatively impacting its conversion to T3.
I'm not taking any supplementary iodine, so I don't know how that could be an issue or what that has to do with rT3 or FT4. I would think those go up because I increased my dose and did my lab draw only a few hours following my NDT dose. The goal right now is to suppress TSH to an optimal level.
Other than iodized salt, eggs and seafood, thyroid hormones(T3 & T4) contain iodine as part of their chemical structure. I'm no expert; just another seeker on the journey to improved health and function. Low iron or ferritin can negatively impact T4 to T3 conversion. Low cortisol the same thing. Low selenium, too. There are people who don't do well on T4, whether alone or in NDT. When I first was prescribed thyroid, it was Cytomel brand, which is T3.
As your free T3 and free T4 increase, your TSH will go down. Again, from what I've read, it sounds like either you're underdosed and your doctor is treating you by the labs or T4 is converting to RT3, blunting uptake of T3.
I just stopped T3/T4 drops because yesterday, I suddenly wasn't feeling well. Dry itchy skin, constipation, worsening food sensitivities, blunted mood. This morning started on T3 drops; 75 mcg, which is where I was at with the combo drops.
Latest TSH: 2.39 (see my full labs here). Goal: TSH between 0.5-1.0.
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When I first started treating my hypothyroidism, it was over 10 years ago and I started with T3 monotherapy. It had little to no effect and did not make me feel better. Since then, I've tried every mono and combination therapy under the sun. I think I will just continue my journey titrating the NDT until I hopefully reach an optimized TSH this time.
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